| NPI | 1285860478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3501) |
| 207Q00000X Family Medicine (Licence: CA 20A15740) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2024-03-21 |